Registrar Room Reservation Request
If you are requesting the use of FLTC 213 A/B, FLTC 214 A/B, FLTC 602, and/or Holden Auditorium, please click here. For all other requests, continue with this form.

Do not use this form if you are scheduling a student group event. Contact Student Programs 362-8541
Please note: Do NOT use this form if you are scheduling a curriculum-related event.
For questions regarding curriculum-related events, contact The Office of Medical Student Education (362-3404).For all other questions regarding room reservations, contact The Office of the Registrar (362-6848).
Items preceded by an asterisk (*) are required:
*Event Date
*Start Time
*End Time
hh:mm AM/PM
hh:mm AM/PM
Request enough time to allow for setup and breakdown for catering, furniture, or equipment.
*Room(s) Requested:
For room details,
click here
NOTE: To select more than one room, hold down the Control Key (Mac users - Apple Key)

Additional dates requested or if room not available alternate room choice:


*Number of attendees:

*Requestor:
On Behalf of:
*E-mail Address:
*Department, Student Organization, or Society:
*Box #:
*Phone #:
FAX #:
Event Name:
*Event Type:
(If "Other", Please Specify):
*Event Description:
*Billing Contact:
*FIS (Billing) Department #:
NOTE: You may only request a room if you are a WUSM department member. If not, you must be sponsored by a WUSM department, fees may be charged, and you are required to complete the Sponsor Information section below:
Sponsor:
The following is REQUIRED for room requests in the Farrell Learning and Teaching Center ONLY:
Catering:

Custodial services required billable at $30.00/hr.:
TABLES

How many? (Maximum 10):
CLEANUP

NOTE: If you select this choice and room(s) are not appropriately cleaned, you will be billed for Custodial Services.
NOTE: The Farrell Learning and Teaching Center allows users to select and contract with any caterer. However, cleanup is the responsibility of the user unless Clean up services are requested above.
Special Instructions:
(i.e. special room configuration, room division, table set-up, etc)

Would you like to order AudioVisual Services or Equipment for this Event now? (If no you may order when you receive your room confirmation.)